[Home peritoneal ultrafiltration in the treatment of chronic heart failure]. / Ultrafiltrazione peritoneale domiciliare (UFPD) nella terapia dello scompenso cardiaco cronico.

Due to its epidemiological characteristics, chronic heart failure refractory to conventional medical treatment is a significant problem involving an increasing number of cardiac patients. Chronic heart failure currently represents one of the most remarkable clinical manifestations of cardiovascular disease because of its frequency, morbidity, impact on quality of life, and costs. The use of new therapeutic approaches is particularly important for patients who become refractory to conventional therapies or are not eligible for heart transplant or other surgical treatment. The benefits of continuous extracorporeal ultrafiltration therapies are well known, but these treatments may be associated with complications and can be used only during hospitalization. Peritoneal ultrafiltration seems to be useful as chronic therapy to improve the quality of life and physical and social rehabilitation of patients with refractory chronic heart failure. The aim of this paper is to evaluate peritoneal ultrafiltration as an integrative treatment in chronic heart failure. Data from the literature suggest that peritoneal ultrafiltration is useful for the preservation of residual renal function, continuous ultrafiltration, hemodynamic stability, better middle-molecule clearance, sodium sieving with maintenance of normonatremia, and reduction of hospital admissions.

Clinical management of patients on peritoneal dialysis in Italy: results from the ATENA study.

BACKGROUND: In Italy, few studies have examined the clinical management of peritoneal dialysis (PD) patients, resulting in a lack of information and awareness. METHODS: A total of 378 PD patients (64.7 ± 14.3 years, 58.9% males) were enrolled across 15 centres in a 12-month retrospective and 6-month prospective study. The primary objective was to evaluate the achievement of Kidney Disease Outcomes Quality Initiative and Kidney Disease Improving Global Outcomes guidelines on recommended target values for anaemia, high blood pressure and mineral metabolism. Comorbidities, hospitalizations, treatment and quality of life were also assessed. RESULTS: Frequent comorbidities included hypertension (87.8%) and cardiovascular disease (39.7%). Peritonitis was the leading cause of hospitalization [12 admissions per 100 person-years (95% confidence interval 9.3-15.2)]. At 6 months, anaemia corrected by erythropoiesis-stimulating agents was observed in 30% of patients and 73% received erythropoiesis-stimulating agents. Systolic and diastolic blood pressures were recorded in 50% and 20% of patients, respectively. Sixty-four percent of echocardiograms revealed left ventricular hypertrophy and 30% of patients had vitamin D <10 ng/mL. Medication to treat intact parathyroid hormone (PTH) included calcitriol (36.3%), paricalcitol (29.2%), cholecalciferol (23.6%) and cinacalcet (21.5%). In a subgroup of patients matched for baseline PTH treated for 1 year, a significant reduction in PTH with paricalcitol (-41%; P < 0.001) but not cinacalcet (+2%; P = 0.63) was observed. Comparison of quality of life domains revealed significant differences for symptoms (P = 0.049), cognitive function (P = 0.019) and social support (P = 0.04) (baseline versus 6 months). CONCLUSIONS: Hypertension and cardiovascular diseases were frequent comorbidities and peritonitis was the leading cause of hospitalization. Secondary hyperparathyroidism and anaemia were common, thus necessitating frequent monitoring of PTH, calcium, phosphorus and haemoglobin.